Responsibility #45

<body topmargin=0 leftmargin=0 marginheight=0 marginwidth=0> <table cellpadding=0 cellspacing=0 border=0><tr> <td valign="top" colspan=2 height=110 BGCOLOR="#666699" TEXT="#080000" bgproperties="fixed" background="04900840erlcjm.png"> <div> <FONT SIZE="5" COLOR="#FFFFFF" FACE="Arial" ><B>NATIONAL SECURITY--Structural,Moral,Economic,Domestic,International</B></FONT><B>     |     </B><A HREF="index.htm" TARGET="_top" TITLE="NATIONAL SECURITYStructural,Moral,Econom"><U><B>home</B></U></A></div> <div> <A HREF="id33.htm" TARGET="_top" TITLE="Responsibility Contents"><U>Responsibility Contents</U></A>   |   <A HREF="id34.htm" TARGET="_top" TITLE="Responsibility 1"><U>Responsibility #1</U></A>   |   <A HREF="id35.htm" TARGET="_top" TITLE="Responsibility 2"><U>Responsibility #2</U></A>   |   <A HREF="id36.htm" TARGET="_top" TITLE="Responsibility 3"><U>Responsibility #3</U></A>   |   <A HREF="id37.htm" TARGET="_top" TITLE="Responsibility 4"><U>Responsibility #4</U></A>   |   <A HREF="id38.htm" TARGET="_top" TITLE="Responsibility 5"><U>Responsibility #5</U></A>   |   <A HREF="id39.htm" TARGET="_top" TITLE="Responsibility 6"><U>Responsibility #6</U></A>   |   <A HREF="id40.htm" TARGET="_top" TITLE="Responsibility 7"><U>Responsibility #7</U></A>   |   <A HREF="id41.htm" TARGET="_top" TITLE="Responsibility 8"><U>Responsibility #8</U></A>   |   <A HREF="id42.htm" TARGET="_top" TITLE="Responsibility 9"><U>Responsibility #9</U></A>   |   <A HREF="id43.htm" TARGET="_top" TITLE="Responsibility 10"><U>Responsibility #10</U></A>   |   <A HREF="id44.htm" TARGET="_top" TITLE="Responsibility 11"><U>Responsibility #11</U></A>   |   <A HREF="id45.htm" TARGET="_top" TITLE="Responsibility 12"><U>Responsibility #12</U></A>   |   <A HREF="id46.htm" TARGET="_top" TITLE="Responsibility 13"><U>Responsibility #13</U></A>   |   <A HREF="id47.htm" TARGET="_top" TITLE="Responsibility 14"><U>Responsibility #14</U></A>   |   <A HREF="id48.htm" TARGET="_top" TITLE="Responsibility 15"><U>Responsibility #15</U></A>   |   <A HREF="id49.htm" TARGET="_top" TITLE="Responsibility 16"><U>Responsibility #16</U></A>   |   <A HREF="id50.htm" TARGET="_top" TITLE="Responsibility 17"><U>Responsibility #17</U></A>   |   <A HREF="id51.htm" TARGET="_top" TITLE="Responsibility 18"><U>Responsibility #18</U></A>   |   <A HREF="id52.htm" TARGET="_top" TITLE="Responsibility 19"><U>Responsibility #19</U></A>   |   <A HREF="id53.htm" TARGET="_top" TITLE="Responsibility 20"><U>Responsibility #20</U></A>   |   <A HREF="id54.htm" TARGET="_top" TITLE="Responsibility 21"><U>Responsibility #21</U></A>   |   <A HREF="id55.htm" TARGET="_top" TITLE="Responsibility 22"><U>Responsibility #22</U></A>   |   <A HREF="id56.htm" TARGET="_top" TITLE="Responsibility 23"><U>Responsibility #23</U></A>   |   <A HREF="id57.htm" TARGET="_top" TITLE="Responsibility 24"><U>Responsibility #24</U></A>   |   <A HREF="id58.htm" TARGET="_top" TITLE="Responsibility 25"><U>Responsibility #25</U></A>   |   <A HREF="id59.htm" TARGET="_top" TITLE="Responsibility 26"><U>Responsibility #26</U></A>   |   <A HREF="id60.htm" TARGET="_top" TITLE="Responsibility 27"><U>Responsibility #27</U></A>   |   <A HREF="id61.htm" TARGET="_top" TITLE="Responsibility 28"><U>Responsibility #28</U></A>   |   <A HREF="id62.htm" TARGET="_top" TITLE="Responsibility 29"><U>Responsibility #29</U></A>   |   <A HREF="id63.htm" TARGET="_top" TITLE="Responsibility 30"><U>Responsibility #30</U></A>   |   <A HREF="id64.htm" TARGET="_top" TITLE="Responsibility 31"><U>Responsibility #31</U></A>   |   <A HREF="id65.htm" TARGET="_top" TITLE="Responsibility 32"><U>Responsibility #32</U></A>   |   <A HREF="id66.htm" TARGET="_top" TITLE="Responsibility 33"><U>Responsibility #33</U></A>   |   <A HREF="id67.htm" TARGET="_top" TITLE="Responsibility 34"><U>Responsibility #34</U></A>   |   <A HREF="id68.htm" TARGET="_top" TITLE="Responsibility 35"><U>Responsibility #35</U></A>   |   <A HREF="id69.htm" TARGET="_top" TITLE="Responsibility 36"><U>Responsibility #36</U></A>   |   <A HREF="id70.htm" TARGET="_top" TITLE="Responsibility 37"><U>Responsibility #37</U></A>   |   <A HREF="id71.htm" TARGET="_top" TITLE="Responsibility 38"><U>Responsibility #38</U></A>   |   <A HREF="id72.htm" TARGET="_top" TITLE="Responsibility 39"><U>Responsibility #39</U></A>   |   <A HREF="id73.htm" TARGET="_top" TITLE="Responsibility 40"><U>Responsibility #40</U></A>   |   <A HREF="id74.htm" TARGET="_top" TITLE="Responsibility 41"><U>Responsibility #41</U></A>   |   <A HREF="id75.htm" TARGET="_top" TITLE="Responsibility 42"><U>Responsibility #42</U></A>   |   <A HREF="id76.htm" TARGET="_top" TITLE="Responsibility 43"><U>Responsibility #43</U></A>   |   <A HREF="id77.htm" TARGET="_top" TITLE="Responsibility 44"><U>Responsibility #44</U></A>   |   <B>Responsibility #45</B>   |   <A HREF="id79.htm" TARGET="_top" TITLE="Responsibility 46"><U>Responsibility #46</U></A>   |   <A HREF="id80.htm" TARGET="_top" TITLE="Responsibility 47"><U>Responsibility #47</U></A>   |   <A HREF="id81.htm" TARGET="_top" TITLE="Responsibility 48"><U>Responsibility #48</U></A>   |   <A HREF="id82.htm" TARGET="_top" TITLE="Responsibility 49"><U>Responsibility #49</U></A>   |   <A HREF="id83.htm" TARGET="_top" TITLE="Responsibility 50"><U>Responsibility #50</U></A>   |   <A HREF="id84.htm" TARGET="_top" TITLE="Responsibility 51"><U>Responsibility #51</U></A>   |   <A HREF="id85.htm" TARGET="_top" TITLE="Responsibility 52"><U>Responsibility #52</U></A>   |   <A HREF="id86.htm" TARGET="_top" TITLE="Responsibility 53"><U>Responsibility #53</U></A>   |   <A HREF="id87.htm" TARGET="_top" TITLE="Responsibility 54"><U>Responsibility #54</U></A>   |   <A HREF="id88.htm" TARGET="_top" TITLE="Responsibility 55"><U>Responsibility #55</U></A>   |   <A HREF="id89.htm" TARGET="_top" TITLE="Responsibility 56"><U>Responsibility #56</U></A>   |   <A HREF="id90.htm" TARGET="_top" TITLE="Responsibility 57"><U>Responsibility #57</U></A>   |   <A HREF="id91.htm" TARGET="_top" TITLE="Responsibility 58"><U>Responsibility #58</U></A>   |   <A HREF="id92.htm" TARGET="_top" TITLE="Responsibility 59"><U>Responsibility #59</U></A>   |   <A HREF="id93.htm" TARGET="_top" TITLE="Responsibility 60"><U>Responsibility #60</U></A>   |   <A HREF="id94.htm" TARGET="_top" TITLE="Responsibility 61"><U>Responsibility #61</U></A>   |   <A HREF="id95.htm" TARGET="_top" TITLE="Responsibility 62"><U>Responsibility #62</U></A>   |   <A HREF="id96.htm" TARGET="_top" TITLE="Responsibility 63"><U>Responsibility #63</U></A>   |   <A HREF="id97.htm" TARGET="_top" TITLE="Responsibility 64"><U>Responsibility #64</U></A>   |   <A HREF="id98.htm" TARGET="_top" TITLE="Responsibility 65"><U>Responsibility #65</U></A>   |   <A HREF="id99.htm" TARGET="_top" TITLE="Responsibility 66"><U>Responsibility #66</U></A>   |   <A HREF="id100.htm" TARGET="_top" TITLE="Responsibility 67"><U>Responsibility #67</U></A>   |   <A HREF="id101.htm" TARGET="_top" TITLE="Responsibility 68"><U>Responsibility #68</U></A>   |   <A HREF="id102.htm" TARGET="_top" TITLE="Responsibility 69"><U>Responsibility #69</U></A>   |   <A HREF="id103.htm" TARGET="_top" TITLE="Responsibility 70"><U>Responsibility #70</U></A>   |   <A HREF="id104.htm" TARGET="_top" TITLE="Responsibility 71"><U>Responsibility #71</U></A>   |   <A HREF="id105.htm" TARGET="_top" TITLE="Responsibility 72"><U>Responsibility #72</U></A>   |   <A HREF="id106.htm" TARGET="_top" TITLE="Responsibility 73"><U>Responsibility #73</U></A>   |   <A HREF="id107.htm" TARGET="_top" TITLE="Responsibility 74"><U>Responsibility #74</U></A>   |   <A HREF="id108.htm" TARGET="_top" TITLE="Responsibility 75"><U>Responsibility #75</U></A>   |   <A HREF="id109.htm" TARGET="_top" TITLE="Responsibility 76"><U>Responsibility #76</U></A>   |   <A HREF="id110.htm" TARGET="_top" TITLE="Responsibility 77"><U>Responsibility #77</U></A>   |   <A HREF="id111.htm" TARGET="_top" TITLE="Responsibility 78"><U>Responsibility #78</U></A>   |   <A HREF="id112.htm" TARGET="_top" TITLE="Responsibility 79"><U>Responsibility #79</U></A>   |   <A HREF="id113.htm" TARGET="_top" TITLE="Responsibility 80"><U>Responsibility #80</U></A>   |   <A HREF="id114.htm" TARGET="_top" TITLE="Responsibility 81"><U>Responsibility #81</U></A>   |   <A HREF="id115.htm" TARGET="_top" TITLE="Responsibility 82"><U>Responsibility #82</U></A>   |   <A HREF="id116.htm" TARGET="_top" TITLE="Responsibility 83"><U>Responsibility #83</U></A>   |   <A HREF="id117.htm" TARGET="_top" TITLE="Responsibility 84"><U>Responsibility #84</U></A>   |   <A HREF="id118.htm" TARGET="_top" TITLE="Responsibility 85"><U>Responsibility #85</U></A>   |   <A HREF="id119.htm" TARGET="_top" TITLE="Responsibility 86"><U>Responsibility #86</U></A>   |   <A HREF="id120.htm" TARGET="_top" TITLE="Responsibility 87"><U>Responsibility #87</U></A>   |   <A HREF="id121.htm" TARGET="_top" TITLE="Responsibility 88"><U>Responsibility #88</U></A>   |   <A HREF="id122.htm" TARGET="_top" TITLE="Health Care Letters to President, et al,"><U>Health Care Letters to President, et al, 8/24/94</U></A>   |   <A HREF="id123.htm" TARGET="_top" TITLE="Arguments for Delay in Enactment of a He"><U>Arguments for Delay in Enactment of a Health Care Bill</U></A>   |   <A HREF="id124.htm" TARGET="_top" TITLE="Post WORLD WAR IIPost COLD WAR Deja Vu"><U>Post WORLD WAR II--Post COLD WAR Deja Vu</U></A>   |   <A HREF="id125.htm" TARGET="_top" TITLE="Responsibility 89"><U>Responsibility #89</U></A>   |   <A HREF="id126.htm" TARGET="_top" TITLE="Responsibility 90"><U>Responsibility #90</U></A>   |   <A HREF="id127.htm" TARGET="_top" TITLE="Responsibility 91"><U>Responsibility #91</U></A>   |   <A HREF="id128.htm" TARGET="_top" TITLE="Responsibility 92"><U>Responsibility #92</U></A>   |   <A HREF="id129.htm" TARGET="_top" TITLE="Responsibility 93"><U>Responsibility #93</U></A>   |   <A HREF="id130.htm" TARGET="_top" TITLE="Responsibility 94"><U>Responsibility #94</U></A>   |   <A HREF="id131.htm" TARGET="_top" TITLE="Responsibility 95"><U>Responsibility #95</U></A>   |   <A HREF="id132.htm" TARGET="_top" TITLE="Responsibility 96"><U>Responsibility #96</U></A>   |   <A HREF="id133.htm" TARGET="_top" TITLE="Responsibility 97"><U>Responsibility #97</U></A>   |   <A HREF="id134.htm" TARGET="_top" TITLE="Responsibility 98"><U>Responsibility #98</U></A>   |   <A HREF="id135.htm" TARGET="_top" TITLE="The Structure of Our Nation is Unsound"><U>The Structure of Our Nation is Unsound</U></A>   |   <A HREF="id136.htm" TARGET="_top" TITLE="Ltr. to Editor, 3/19/96, Property Taxes "><U>Ltr. to Editor, 3/19/96, Property Taxes and Education Funding</U></A></div> <div> </div> </td> </tr><tr> <td valign="top" width=190 BGCOLOR="#CCCCFF" TEXT="#080000" background="04311c00egdysm.png"> <bR> </td> <td valign="top" height=370 BGCOLOR="#FFFFFF" TEXT="#080000"> <div> Responsibility #45</div> <div> (written prior to July 1992)</div> <bR> <div> To the People of the United States of America:</div> <bR> <div>      We will wrap up Health Care with the discussion of a few special topics.</div> <bR> <div> 11.Health Care Clearing House (HCCH) as arbiter and friend of the court.</div> <bR> <div> HCCH could serve as arbiter among the insured, the health care provider, and the insurer.  It can also serve as friend of the court when arbitration does not suffice.  With the central and expert role of HCCH, it is expected that disputes will be infrequent, and resort to the courts will be rare.  The availability of macro and micro data and analyses from the HCCH should inhibit frivolous disputes, and enhance the fairness of arbitrations and trials.</div> <bR> <div> 12.HCCH as coordinator for acceptance of new equipment and techniques.</div> <div>          </div> <div> HCCH can serve to expedite the availabilities of better equipment and techniques by helping providers, insurers, and the government agree on risk bearing and cost sharing of tests of promising improvements in health care.  Its data and analyses can assist medical industry decisions on the best allocations of equipment, thereby holding down the costs of health care.</div> <div> 13.Annual physical and special exams as preventive medicine.</div> <div> As a part of the establishment and maintenance of standard policies, annual and special periodic (mammograms, pap tests, prostate, etc.) exams should be prescribed and required.  In addition to early detection of "normal" health problems, they will serve to uncover AIDS, venereal diseases, child or spouse abuse, cancer, heart trouble, drugs and tobacco use, and alcohol abuse.</div> <div> These tests should be conducted using the economies of scale, with copies of the results being supplied to the normal health care provider.  Health care hubs (hospitals, medical complexes, and mobile units) would be used as appropriate for particular urbane, suburban and rural locations.</div> <div> Medical practices would be relieved of these "routine" functions. They can spend their time more effectively in treatment and counseling.  The scheduling and notification function could be accomplished by HCCH.  </div> <div> The notifications to the insureds should stress their responsibility to attend to the prescribed (prepaid) tests.  Enclosed would be a warning that failure to do so may impair their health, entail higher premiums, and prejudice their case with future health problems.</div> <div> 14.HCCH organization.</div> <bR> <div> This could be federal civil service, a small federal office controlling states civil service groups, or a small federal office overseeing contracts with regional or state private contractors.</div> <div> 15.Who pays for HCCH?</div> <div> Since health care will be "universal", a number of funding choices would be consistent with the creed of these Responsibility papers.  The preferred method would be to add charges to the billings to the insurers and subtract charges from the payments to health care providers to amortize the "regular" costs of HCCH functions.  All parties that cause "special" functions would be charged for them.  The last criteria would inhibit departures from the efficiency and effectiveness of the "regular" functions.</div> <div> 16.Health care in rural areas. </div> <div> There is no easy answer to limitations in availability, and the higher costs of health care in rural areas.      Scholarship and education loan payoff inducements, for new doctors and nurses to devote at least a few years in rural practice, continue to have merit.  The annual physical and special exams conducted by mobile units, and provided under the standard policies, will reduce the frequency of unexpected health problems.  The standard policies could have special addendums and premiums, to guard against the high cost of medical evacuation flights or surface transportation.</div> <div> 17.Government sponsored health care and facilities.</div> <div> A newspaper editorial of December 26, 1991, began with the sentence: "Although it comes nowhere close to rectifying the ills of our nation's health care system, the decision by the Department of Veterans Affairs to provide treatment to non-veterans at some of its rural hospitals is a small step in the right direction."  The article ended with the sentence: "If health care is made more accessible and more affordable for everyone, even the nation's deserving veterans will be better served."      </div> <div> The efficiency and effectiveness of government sponsored health care should not be impeded by political considerations.  To the extent that the care of Medicare and Medicaid (and State substitutes) patients, veterans, government employees and retirees, and active and retired military plus dependents, can be integrated without significant compromise in quality, it should be done.   </div> <div> The governments would pay for policies for the people for whom they have taken on the health care responsibility, and who are economically insurable.  Government facilities and medical personnel could then be held to a minimum.</div> <div>   </div> <div> Veterans hospitals, or veterans departments within other government or private hospitals, would still be required for their expertise in veterans related health care.  Military hospitals or dispensaries, as needed for force structure considerations, would still be maintained.  To the extent that veterans and military facilities provide non-service related health care (care covered by the standard policies), they would make claims against the policies like any other provider.  Veterans, military, public (federal, state, county, and city) facilities would continue to provide care not covered by insurance policies under taxpayer funding. </div> <div> 18.Long-term, nursing home, care.</div> <div> High cost of last year/month care of those over 65.</div> <div> Extraordinary neonatal care.</div> <div> Seemingly endless comas, etc.</div> <div> There is no pleasing answer to these enigmas.  The decisions are related to prolonging lives, not taking lives.  It is intended that the definitions of coverage within each level of standard policy will clearly communicate the extent of responsibility of the insurance companies.  Thus the "rationing" decision will have been made by or for the insured before the fact.  If the insured or his family decides to exceed the policy provisions, they will need to assure that they have the resources to do so.  The government's "safety net" would be based on the minimum standard policy.</div> <bR> <div>      The Presidential and Congressional election and operational reforms previously discussed, and the health care changes proposed in the last four essays, will cure the interference of health care and insurance company PACs and lobbies.  Medical malpractice will be discussed in the next essay, which is devoted to the subject of Litigation.</div> <div>                     Publius IV</div> <bR> <div> <A HREF="id79.htm" TARGET="_top" TITLE="Responsibility 46"><U>Responsibility #46</U></A></div> <div> Back to: <A HREF="id33.htm" TARGET="_top" TITLE="Responsibility Contents"><U>Responsibility Contents</U></A>        </div> </td> </tr></table></body>